We sent a few questions to Medicare about the coverage update, including when CMS will publish coding guidance for the service, what practices should do with any claims for services before the change request’s April 6 implementation date and whether
P-Stim and other electroauricular acupuncture systems will be covered, so stay tuned. In the meantime, take in the full descriptors and national non-facility reimbursement rates for the codes:
20560 Needle insertion(s) without injection(s); 1 or 2 muscle(s) – $25.74.
20561 Needle insertion(s) without injection(s); 3 or more muscles – $38.32.
97810 Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient – $37.03.
97811 Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure) – $28.47.
97813 Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient – $41.15.
97814 Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure) – $33.91.
CMS has not created a medically unlikely edit (MUE) for the dry needling codes, but the MUE for the acupuncture codes is currently set at 0. Watch the the April MUE update for a change.
Here are a few more coding points from the 2020 CPT manual:
- Count face-to-face time for the acupuncture codes. The clock starts when the clinician applies the needles, stops if she leaves the room, and starts again when she returns.
- You may report acupuncture with and without electrical stimulation for the same patient on the same day, but you can only report one primary code. For example, if the doctor performs 15 minutes of acupuncture with electrical stimulation followed by 15 minutes of acupuncture without, you would report one unit of 97813 and one unit of add-on code 97811.
- Dry needling is bundled into the acupuncture codes. Because medical coding is never simple, you may see dry needling referred to as trigger point acupuncture. Make sure you know what the doctor or other clinician did to avoid errors.